Case Omsk pada Anak

8/18/2019 Case Omsk pada Anak

1/22

FAKULTAS KEDOKTERAN UKRIDA

(UNIVERSITAS KRISTEN KRIDA WACANA)

Jl. Terusan Arjuna no.6 Keon Jeru!" Ja!ar#a$%ara#

KE&ANITERAAN KLINIK

STATUS IL'U &ENAKIT TT

FAKULTAS KEDOKTERAN UKRIDA

S'F &ENAKIT TT

RU'A SAKIT U'U' DAERA KOJA

Na*a + Sa*an#,a Tan-a Tanan

N/* + 00$1203$445

Dr. &e*/*/n + -r. Arro7an War-ana," S8TT Tan-a Tanan

IDENTITAS &ASIEN

Na*a + An. N Jen/s Kela*/n + &ere*8uan

U*ur + 3 #a,un Aa*a + Isla*

Tl la,/r + 09:25:1200

ANA'NESA

D/a*/l se;ara + alloana*nes/s

&a-a #anal + 5 Dese*er 120< 8a-a ja* 02.22

Kelu,an U#a*a + !u8/n !/r/ !eluar ;a/ran #erus *enerus sela*a 1 ulan

Kelu,an Ta*a,an + a#u! -an 8/le!

R/=a7a# 8en7a!/# se!aran +


2/22

Seoran /u *e*a=a ana!n7a erus/a 3 #a,un !arena !eluar ;a/ran -ar/ #el/na !/r/ sela*a

1 ulan. San /u jua *enelu, seelu*n7a ana!n7a *enala*/ a#u! 8/le! seelu* !eluar

;a/ran -ar/ #el/na. %a#u! 8/le! se*8a# se*u, lalu #/*ul la/. San ana! se*8a# -e*a*

#e#a8/ saa# -a#an !e 8ol/ #/-a! -e*a* la/. D/!e#a,u/ ana! su!a jajan se*aranan #eru#a*a

*en!onsu*s/ es -an jajanan aan$aan -/ -e!a# se!ola,. San ana! jua -/!e#a,u/ su!a

er*a/n -/ #ana, *era, -enan #e*an$#e*ann7a. %eera8a #e*an san ana! jua ser/n

*enala*/ a#u! 8/le!. &a-a 8e*er/!saan >/s/! -/#e*u!an #ons/l *e*esar T4$T1. Ana!

#/-a! *e*/l/!/ r/=a7a# aler/.

R/=a7a# 8en7a!/# -a,ulu +

San ana! ser/n *enala*/ ,al seru8a 7a/#u !eluar ;a/ran -ar/ #el/na -ar/ #a,un 1201. Ana!

ser/n !al/ *enala*/ a#u! 8/le! 7an ,/lan #/*ul -/ser#a/ -enan sa!/# #enoro!an.

Karena !e#era#asan =a!#u san /u #/-a! 8erna, !on#rol !e#/!a oa# ,a/s. Se,/na elu*

se*u, #o#al" ana! #/-a! !e*al/ -/8er/!sa. R/=a7a# /*un/sas/ -/!e#a,u/ len!a8.

&e*er/!saan F/s/!

KU + Co*8os *en#/s" #a*8a! sa!/# r/nan

%% + 0?K

T% + ?1;*

Tel/na

%en#u! -aun #el/na + Nor*o#/a ADS

Kela/nan !onen/#al + #/-a! a-a ADS

Ra-an" #u*or + #/-a! a-a ADS

N7er/ #e!an #raus + #/-a! a-a ADS

Kela/nan &re" /n>ra" -an re#roaur/!uler + #/-a! a-a ADS

Re/on 'as#o/- + #/-a! a-a n7er/ #e!an ADS

L/an #el/na + #er-a8a# 8er>oras/ AS

'e*ran #7*8an/ + u#u, AD

/-un

%en#u! + nor*al" #/-a! a-a !re8/#as/

S/nus >ron#al/s -an *a@/llar/s + #/-a! a-a n7er/ #e!an

Ves#/ulu* + #/-a! #erl/,a# a-a 8en7e*8/#an a#au *assa

Cau* nas/ + #erl/,a# se;re# serous

Kon!a /n>er/or + nor*al

'ea#us /n>er/or + la8an !/r/ -an !anan


3/22

Kon!a *e-/us + #erl/,a# ,/8ere*/s

'ea#us *e-/us + la8an

Se8#u* nas/ + #/-a! a-a -e/as/ se8#u*

Tenoro!an

D/n-/n >ar/n + #erl/,a# ,/8ere*/s

Tons/l + T4$T1

Uula + nor*al

Resu*e +

Ana! N -a#an !e 8ol/ TT !oja -enan !elu,an !eluar ;a/ran -ar/ #el/na seja! 4 ,ar/ lalu

-/ser#a/ a#u! 8/le!. Ana! ser/n jajan se*aranan -an er*a/n -/ #e*8a# 7an !o#or. Ana! ser/n *en-er/#a ,al 7an seru8a -ar/ #a,un 1201. Ana! #/-a! *e*/l/!/ r/=a7a# aler/.

R/=a7a# /*un/sas/ -/!e#a,u/ len!a8.

Dar/ 8e*er/!saan >/s/! -/-a8a#!an+

Tel/na

K/r/ + nor*o#/a" #/-a! a-a n7er/ #e!an #raus" #/-a! a-a !ela/nan 8re" /n>ra" re#roaur/!uler"

#/-a! a-a n7er/ #e!an *as#o/-" luan #el/na ,/8ere*/s" #er-a8a# se!re# !e!un/nan" 8er>oras/

8a-a *e*ran #/*8an/

Kanan + nor*o#/a" #/-a! a-a n7er/ #e!an #raus" #/-a! a-a !ela/nan 8re" /n>ra" re#roaur/!uler"

#/-a! a-a n7er/ #e!an *as#o/-" luan #el/na #erl/,a# la8an" *e*ran #/*8an/ u#u,

/-un +

/-un #a*8a! nor*al" #/-a! a-a !re8/#as/" es#/ulu* #erl/,a# #/-a! a-a *assa" #erl/,a# a-a

se;re# serous" !on!a -an *ea#us /n>er/or #erl/,a# #/-a! a-a !ela/nan" #/-a! -/#e*u!an -e/as/

se8#u*.

Tenoro!+

Uula #erl/,a# nor*al" #ons/l T4$T1" #erl/,a# *u!osa >ar/n ,/8ere*/s.

Working Diagnosis:

O'SK As

Penatalaksanaan :

Non-medikamentosa :

Cu;/ #el/na -enan 1O1 4B 4$


4/22

T/-a! *enore! #el/na

T/-a! erenan -an #/-a! ole, #er!ena a/r

Medikamentosa :

Oa# #e#es #el/na 7an *enan-un an#//o#/! -an !or#/!os#ero/- o#o8a/n ear -ro8 4@ ##0

A/#ro*/s/n s7ru8 1@ se,ar/ 0 sen-o! #e, (-os/s 02*:!:,ar/)

R,/nos s7ru8 4@ se,ar/ 0 sen-o! #e,

Edukasi :

'enjaa !eers/,an -/r/

'a!an *a!anan 7an #erar#ur" se,a#" -an ers/,

Ser/n ;u;/ #el/na -an *en,/n-ar/ #er!ena a/r 8a-a #el/na

T/-a! jajan se*aranan

'/nu* /#a*/n un#u! *enjaa !on-/s/ !ese,a#an ana!

Prognosis :

O*s! #/8e en/n a- ona* (j/!a #/-a! -/#anan/ #un#as a!an #/*ul !e!a*u,an)


5/22

Tinjauan Pustaka

Otitis Media Supuratif Kronik

O#/#/s *e-/a su8ura#/> !ron/s (O'SK) -a,ulu -/seu# o#/#/s *e-/a 8er>ora#e (O'&)

a#au -ala* seu#an se,ar/ ,ar/ ;one!. an -/seu# o#/#/s *e-/a su8ura#/> !ron/s /ala, /n>e!s/

!ron/s -/ #el/na #ena, -enan 8er>oras/ *e*rane #/*8an/ -an se;re# 7an !eluar -ar/

#el/na #ena, #erus *enerus a#au ,/lan #/*ul. Se;re# *un!/n en;er a#au !en#al" en/n

a#au eru8a nana,. 0

Perjalanan penyakit

O#/#/s *e-/a a!u# -enan 8er>oras/ *e*rane #/*8an/ *enja-/ o#/#/s *e-/a su8ura#/>

!ron/s a8a/la 8roses /n>e!s/n7a !uran -ar/ 1 ulan" -/seu# o#/#/s *e-/a su8ura#/> sua!u#. 0

%eera8a >a;#or 7an *en7ea!an O'A *enja-/ O'SK /ala, #era8/ 7an #erla*a#

-/er/!an" #era8/ 7an #/-a! a-e!ua#" /rulens/ !u*an #/n/" -a7a #a,an #uu, 8as/en ren-a,

(// !uran) a#au ,7/ene uru!. 0

etak perforasi

Le#a! 8er>oras/ -/ *e*rane #/*8an/ 8en#/n un#u! *enen#u!an #/8e:jen/s O'SK.

&er>oras/ *e*rane #/*8an/ -a8a# -/#e*u!an -/ -aera, sen#ral" *ar/nal" a#au a#/!. &a-a

8er>oras/ sen#ral" 8er>oras/ #er-a8a# -/ 8ars #ensa" se-an!an -/ seluru, #e8/ 8er>oras/ *as/,

a-a s/sa *e*rane #/*8an/. &a-a 8er>oras/ *ar/nal sea/an #e8/ 8er>oras/ lansun

er,uunan -enan annulus a#au sul!us #/*8an/!u*. &er>oras/ a#/! /ala, 8er>oras/ 7an

#erle#a! -/ 8ars >la!s/-a. 0

!enis OMSK

O'SK -a8a# -/a/ a#as 1 jen/s" 7a/#u

0. O'SK #/8e a*an (#/8e *u!osa #/8e en/n)

1. O'SK #/8e a,a7a (#/8e #ulan #/8e *al/na) 0

%er-asar!an a!#//#as se;re# 7an !eluar -/!enal jua+

0. O'SK a!#/>

O'SK -enan se;re# 7an !eluar -ar/ !au* #/*8an/ se;ara a!#/>. 0

&a-a jen/s /n/ #er-a8a# se!re# 8a-a #el/na -an #ul/. %/asan7a -/-a,ulu/ ole, 8erluasan

/n>e!s/ saluran na>as a#as *elalu/ #ua eu#a;,/us" a#au se#ela, erenan -/*ana

!u*an *asu! *elalu/ l/a n #el/na luar. Se!re# erar/as/ -ar/ *u!o/- sa*8a/


6/22

*u!o8urulen. U!uran 8er>oras/ erar/as/ -ar/ seesar jaru* sa*8a/ 8er>oras/

su#o#al 8a-a 8ars #ensa. Jaran -/#e*u!an 8ol/8 7an esar 8a-a l/an #el/na luas.

&erluasan /n>e!s/ !e sel$sel *as#o/- *ena!/a#!an 8en7earan 7an luas -an

8en7a!/# *u!osa 7an *ene#a8 ,arus -/;ur/a/ /la #/n-a!an !onsera#/> aal un#u!

*enon#rol /n>e!s/" a#au j/!a ranulas/ 8a-a *eso#/*8anu* -enan a#au #an8a

*/ras/ se!un-er -ar/ !ul/#" -/*ana !a-an$!a-an a-an7a se!re# 7an er8ulsas/

-/a#as !ua-ran 8os#erosu8er/or.4

1. O'SK #enan

O'SK #enan /ala, 7an !ea-aan !au* #/*8an/n7a #erl/,a# asa, a#au !er/n.0

&a-a 8e*er/!saan #el/na -/ju*8a/ 8er>oras/ #o#al 7an !er/n -enan *u!osa #el/na

#ena, 7an 8u;a#. ejala 7an -/ju*8a/ eru8a #ul/ !on-u!#/> r/nan. ejala la/n

7an -/ju*8a/ se8er#/ er#/o" #/n/#us"a#au sua#u rasa 8enu, -ala* #el/na. 4

Fa!#or 8re-/s8os/s/ 8a-a 8en7a!/# #uo#/*8an/ +a. In>e!s/ saluran na>as 7an erulan" aler/ ,/-un" r,/nos/nus/#/s !ron/s.

. &e*esaran a-eno/- 8a-a ana!" #ons/l/#/s !ron/s.

;. 'an-/ -an erenan -/!ola* renan" *en!ore! #el/na -enan ala# 7an

#er!on#a*/nas/.

-. 'alnu#r/s/ -an ,/8oa**aloul/ne*/a.

e. O#/#/s *e-/a su8ura#/> a!u# 7an erulan. 4

&roses 8era-anan 8a-a O'SK #/8e a*an #era#as 8a-a *u!osa saja" -an /asan7a

#/-a! *enena/ #ulan. &er>oras/ #erle#a! -/ sen#ral. U*u*n7a O'SK #/8e a*an jaran*en/*ul!an !o*8l/!as/ 7an era,a7a. &a-a O'SK #/8e a*an #/-a! #era-a8a#

!oles#ea#o*a. 0

an -/*a!su- -enan O'SK #/8e *al/na /ala, O'SK 7an -/ser#a/ -enan

!oles#ea#o*a. O'SK /n/ -/!enal jua -enan O'SK #/8e a,a7a a#au O'SK #/8e #ulan.

&er>oras/ 8a-a O'SK #/8e a,a7a le#a!n7a *ar/nal a#au -/ a#/!" !a-an !a-an #er-a8a#

jua !oles#ea#o*a 8a-a O'SK -enan 8er>oras/ su#o#oal. Sea/an esar !o*8l/!as/ 7an

era,a7a a#au >a#al #/*ul 8a-a O'SK #/8e a,a7a. 0

Tan-a$#an-a !l/n/s O'SK #/8e *al/na +

0. A-an7a Ases a#au >/s#el re#roaur/!ular

1. Jar/nan ranulas/ a#au 8ol/8 -/l/an #el/na 7an erasal -ar/ !au* #/*8an/.

4. &us 7an selalu a!#/> a#au erau usu! ( aro*a !oles#ea#o*)

3. Fo#o ron#en *as#o/- a-an7a a*aran !oles#ea#o*.4

Epidemiologi


7/22

&realens/ O'SK 8a-a eera8a neara an#ara la/n -/sea!an" !on-/s/ sos/al"

e!ono*/" su!u" #e*8a# #/nal 7an 8a-a#" ,7/ene -an nu#r/s/ 7an jele!. Kean7a!an

*ela8or!an 8realens/ O'SK 8a-a ana! #er*asu! ana! 7an *e*8un7a/ !oles#ea#o*. D/

In-ones/a sen-/r/ -/!e#a,u/ 8realens/ O'SK a-ala, 4B 8en-u-u!.3

Etiologi

Terja-/ O'SK ,a*8/r selalu -/*ula/ -enan o#/#/s *e-/a erulan 8a-a ana!" jaran

-/*ula/ se#ela, -e=asa. Fa!#or /n>e!s/ /asan7a erasal -ar/ naso>ar/n (a-eno/-/#/s"

#ons/l/#/s" r/n/#/s" s/nus/#/s)" *en;a8a/ #el/na #ena, *elalu/ #ua Eus#a;,/us. Funs/ #ua

Eus#a;,/us 7an anor*al *eru8a!an >a!#or 8re-/s8os/s/ 7an -/ju*8a/ 8a-a ana! -enan

;le># 8ala#e -an Do=ns s7n-ro*. Fa!#or os# 7an er!a/#an -enan /ns/-en O'SK 7an

rela#/> #/n/ a-ala, -e>/s/ens/ /**un s/s#e*/!. 4

Manifestasi Klinis

"# Tel/na era/r (o#orr,oe)

Se!re# ers/>a# 8urulen ( !en#al" 8u#/,) a#au *u!o/- ( se8er#/ a/r -an en;er)

#eran#un s#a-/u* 8era-anan. Se!re# 7an *u!us -/,as/l!an ole, a!#//#as !elenjar

se!re#or/! #el/na #ena, -an *as#o/-. &a-a O'SK #/8e j/na!" ;a/ran 7an !eluar

*u!o8us 7an #/-a! erau usu! 7an ser/n !al/ seaa/ rea!s/ /r/#as/ *u!osa

#el/na #ena, ole, 8er>oras/ *e*ran #/*8an/ -an /n>e!s/. Keluarn7a se!re#

/asan7a ,/lan #/*ul. 'en/n!a#n7a ju*la, se!re# -a8a# -/sea!an /n>e!s/ saluran

na>as a#as a#au !on#a*/nas/ -ar/ l/an #el/na luar se#ela, *an-/ a#au erenan. 1"4

&a-a O'SK s#a-/u* /na!#/> #/-a! -/ju*8a/ a-ann7a se!re# #el/na. Se!re#

7an sana# au" er=arna !un/n au$au !o#or *e*er/ !esan !oles#ea#o*a -an 8ro-u! -eeneras/n7a. Da8a# #erl/,a# !e8/n$!e8/n !e;/l" er=arna 8u#/,"

*en!/la8. &a-a O'SK #/8e anas unsur *u!o/- -an se!re# #el/na #ena,

er!uran a#au ,/lan !arena rusa!n7a la8/san *u!osa se;ara luas. Se!re# 7an

er;a*8ur -ara, er,uunan -enan a-an7a jar/nan ranulas/ -an 8ol/8 #el/na

-an *eru8a!an #an-a a-an7a !oles#ea#o* 7an *en-asar/n7a. Sua#u se!re# 7an

en;er era/r #an8a n7er/ *enara, !e*un!/nan #uer!ulos/s. 4

$# anuan 8en-enaran

In/ #eran#un -ar/ -eraja# !erusa!an #ulan$#ulan 8en-enaran. %/asan7a

-/ju*8a/ #ul/ !on-u!#/> na*un -a8a# 8ula ers/>a# ;a*8uran. anuan 8en-enaran


8/22

*un!/n r/nan se!al/8un 8roses 8a#olo/ sana# ,ea#" !arena -aera, 7an sa!/#

a#au8un !oles#ea#o*" -a8a# *en,a*a# un7/ -enan e>e!#/> !e >enes#ra oal/s. %/la

#/-a! -/ju*8a/ !oles#ea#o*" #ul/ !on-u!#/> !uran -ar/ 12 - /n/ -/#an-a/ a,=a ran#a/

#ulan 8en-enaran *as/, a/!. Kerusa!an -an >/!sas/ -ar/ ran#a/ #ulan 8en-enaran

*en,as/l!an 8enurunan 8en-enaran le/, -ar/ 42 -.1"4

%era#n7a !e#ul/an #eran#un -ar/ esar -an le#a! 8er>oras/ *e*ran #/*8an/

ser#a !eu#u,an -an *o/l/#as s/s#e* 8enan#aran suara !e #el/na #ena,. &a-a

O'SK #/8e *al/na /asan7a -/-a8a# #ul/ !on-u!#/> era# !arena 8u#usn7a ran#a/

#ulan 8en-enaran" #e#a8/ ser/n !al/ jua !oles#ea#o* er#/n-a! seaa/ 8en,an#ar

suara se,/na a*an 8en-enaran 7an -/-a8a# ,arus -//n#er8re#as/!an se;ara ,a#/$

,a#/. &enurunan >uns/ !o,lea /asan7a #erja-/ 8erla,an$la,an -enan erulann7a

/n>e!s/ !arena 8ene#ras/ #o!s/n *elalu/ jen-ela ula# (>ora*en ro#un-u*) a#au >/s#el

la/r/n #an8a #erja-/n7a la/r/n/#/s su8ura#/>. %/la #erja-/n7a la/r/n/#/s su8ura#/> a!an

#erja-/ #ul/ sara> era#" ,an#aran #ulan -a8a# *ena*ar!an s/sa >uns/ !o,lea. 4

%# O#al/a ( n7er/ #el/na)

N7er/ #/-a! la/* -/!elu,!an 8en-er/#a O'SK" -an /la a-a *eru8a!an sua#u

#an-a 7an ser/us. &a-a O'SK !elu,an n7er/ -a8a# !arena #eren-unn7a -ra/nase

8us. N7er/ -a8a# erar#/ a-an7a an;a*an !o*8l/!as/ a!/a# ,a*a#an 8enal/ran

se!re#" #er8a8arn7a -ura*e#er a#au -/n-/n s/nus la#eral/s" a#au an;a*an

8e*en#u!an ases o#a!. N7er/ #el/na *un!/n a-a #e#a8/ *un!/n ole, a-an7a

o#/#/s e!s#erna se!un-er. N7er/ *eru8a!an #an-a er!e*an !o*8l/!as/ O'SK

se8er#/ &e#ros/#/s" su8er/os#eal ases a#au #ro*os/s s/nus la#eral/s. 4

Ver#/o

Ver#/o 8a-a 8en-er/#a O'SK *eru8a!an ejala 7an ser/us la/nn7a. Kelu,an

er#/o ser/n!al/ *eru8a!an #an-a #ela, #erja-/n7a >/s#el la/r/n a!/a# eros/ -/n-/n

la/r/n ole, !oles#ea#o*. Ver#/o 7an #/*ul /asan7a a!/a# 8erua,an #e!anan

u-ara 7an *en-a-a! a#au 8a-a 8an-er/#a 7an sens/#/> !elu,an er#/o -a8a# #erja-/

,an7a !arena 8er>oras/ esar *e*ran #/*8an/ 7an a!an *en7ea!an la/r/n le/,

*u-a, #eransan ole, 8ere-aan su,u. &en7earan /n>e!s/ !e -ala* la/r/n jua

a!an *e7ea!an !elu,an er#/o. Ver#/o jua /sa #erja-/ a!/a# !o*8l/!as/

sereelu*. F/s#ula *eru8a!an #e*uan 7an ser/us" !arena /n>e!s/ !e*u-/an -a8a#

erlanju# -ar/ #el/na #ena, -an *as#o/- !e #el/na -ala* se,/na #/*ul la/r/n/#/s

-an -ar/ sana *un!/n erlanju# *enja-/ *en/n/#/s. Uj/ >/s#ula 8erlu -/la!u!an 8a-a

!asus O'SK -enan r/=a7a# er#/o. Uj/ /n/ *e*erlu!an 8e*er/an #e!anan 8os/#/>


9/22

-an nea#/> 8a-a *e*ran #/*8an/" -enan -e*/!/an -a8a# -/#erus!an *elalu/

rona #el/na #ena,.4

Diagnosis

D/anos/s O'SK -/ua# er-asar!an ejala !l/n/! -an 8e*er/!saan TT #eru#a*a

8e*er/!saan o#os!o8/. &e*er/!saan 8enala *eru8a!an 8e*er/!saan se-er,ana un#u!

*ene#a,u/ a-an7a anuan 8en-enaran. Un#u! *ene#a,u/ jen/s -an -eraja# anuan

8en-enaran -a8a# -/la!u!an 8e*er/!saan au-/o*e#r/ na-a *urn/" au-/o*e#r/ #u#ur (s8ee;,

au-/o*e#r7) -an 8e*er/!saan %ERA (ra/ns7s#e* eo!e- res8onse au-/o*e#r7) a/ 8as/en:

ana! 7an #/-a! !oo8era#/> -enan 8e*er/!saan au-/o*e#r/ na-a *urn/.

0

&e*er/!saan 8enunjan la/n eru8a >o#o ron#en *as#o/- ser#a !ul#ur -an uj/ res/s#ens/

!u*an -ar/ se;re# #el/na. 0

Kolesteatoma

Koles#ea#o*a a-ala, sua#u !/s#a e8/#er/al 7an er/s/ -es!ua*as/ e8/#el (!era#/n).

Des!ua*as/ #eren#u! #erus lalu *enu*8u! se,/na !oles#ea#o*a er#a*a, esar. 0

Is#/la, !oles#ea#o*a *ula/ -/8er!enal!an ole, Jo,anes 'uller 8a-a #a,un 0949 !arena

-/san!a !oles#ea#o*a *eru8a!an sua#u #u*or" 7an #ern7a#a u!an. %eera8a /s#/la, la/n

7an -/8er!enal!an ole, 8ara a,l/ an#ara la/n a-ala, + !era#o*a (S;,u;!ne;,#)" sGua*ous

e8/#el/os/s" !oles#ea#os/s" e8/-er*o/- !oles#ea#o*a" !/s#a e8/-er*o/-" e8/-er*os/s. 0

&a#,oenes/s

%an7a! #eor/ -/!e*u!a!an ole, 8ara a,l/ #en#an 8a#,oenes/s !oles#ea#o*a" an#ara

la/n a-ala, #eor/ /na/nas/" #eor/ */ras/" #eor/ *e#a8las/a" -an #eor/ /*8lan#as/. Teor/


10/22

#erseu# a!an le/, *u-a, -/8a,a*/ /la -/8er,a#/!an -e>/n/s/ !oles#ea#o*a *enuru# ra7

(0?63) 7an *ena#a!an" !oles#ea#o*a a-ala, e8/#el !ul/# 7an era-a 8a-a #e*8a# 7an

sala," a#au *enuru# 8e*a,a*an 8enul/sH !oles#ea#o*a -a8a# #erja-/ ole, !arena a-an7a e8/#el

!ul/# 7an #er8eran!a8. 0

Seaa/*ana !/#a !e#a,u/ a,=a seluru, e8/#el !ul/# (keratinizing stratified squamous

epithelium) 8a-a #uu, !/#a era-a 8a-a lo!as/ 7an #eru!a:#er8a8ar !e -un/a luar. E8/#el

!ul/# -/ l/an #el/na *eru8a!an sua#u -aera, Cul-de-sac se,/na a8a/la #er-a8a# seru*en

8a-a# -/ #el/na 8a-a =a!#u 7an la*a *a!a -ar/ e8/#el !ul/# 7an era-a *e-/al -ar/

seru*en #erseu# sea!an #er8eran!a8 se,/na *e*en#u! !oles#ea#o*a. 0

Klas/>/!as/0

Koles#ea#o*a -a8a# -/a/ a#as 1 jen/s+

0. Koles#ea#o*a !onen/#al 7an #eren#u! 8a-a *asa e*r/on/! -an -/#e*u!an 8a-a

#el/na -enan *e*rane #/*8an/ u#u, #an8a #an-a #an-a /n>e!s/. Lo!as/ !oles#ea#o*

/asan7a -/ !au* #/*8an/" -aera, 8e#rosus *as#o/- a#au -/ cerebellopontin angle.

Koles#ea#o*a -/ cerebellopontin angle ser/n -/#e*u!an se;ara #/-a! senaja ole,

a,l/ e-a, sara>.

1. Koles#ea#o*a a!u/s/#al 7an #eren#u! se#ela, ana! la,/r" jen/s /n/ #era/ a#as 1 +

a. Koles#ea#o*a a!u/s/#al 8r/*er Koles#ea#o*a 7an #eren#u! #an8a -/-a,ulu/ ole, 8er>oras/ *e*rane

#/*8an/. Koles#ea#o*a #/*ul a!/a# #erja-/ 8roses /na/nas/ -ar/ *e*rane

#/*8an/ 8ars >la!s/-a !arena a-an7a #e!anan nea#/e -/ #el/na #ena, a!/a#

anuan #ua (#eor/ /na/nas/)

. Koles#ea#o*a a!u/s/#al se!un-er

Koles#ea#o*a #eren#u! se#ela, a-an7a 8er>oras/ *e*rane #/*8an/.

Koles#ea#o*a #eren#u! seaa/ a!/a# -ar/ *asu!n7a e8/#el !ul/# -ar/ l/an

#el/na a#au -ar/ 8/n/r 8er>oras/ *e*rane #/*8an/ !e #el/na #ena, (Teor/

*/ras/) a#au #erja-/ a!/a# *e#a8las/a *u!osa !au* #/*8an/ !arena /r/#as/

/n>e!s/ 7an erlansun la*a (Teor/ *e#a8las/a) 0

&a-a #eor/ /*8lan#as/ -/!a#a!an a,=a !oles#ea#o*a #erja-/ a!/a# /*8lan#as/ e8/#el

!ul/# se;ara /a#roen/; !e -ala* #el/na #ena, se=a!#u o8eras/" se#ela, blust injury"

8e*asanan 8/8a en#/las/ a#au se#ela, */r/no#o*/. 0

Koles#ea#o*a *eru8a!an *e-/a 7an a/! un#u! #e*8a# 8er#u*u,an !u*an(/n>e!s/)" 7an 8al/n ser/n a-ala, &ro#eus -an &seu-o*onas Aeru/nosa. Seal/!n7a /n>e!s/


11/22

-a8a# *e*/;u res8ons /*un lo;al 7an *ena!/a#!an 8ro-u!s/ eraa/ *e-/a#or /n>la*as/

-an eraa/ s/#o!/n. S/#o!/n 7an -//-en#/>/!as/ #er-a8a# 8a-a *a#r/!s !oles#ea#o*a a-ala,

/n#erleu!/n (IL$0)" /n#erleu!/n$6" #u*or ne;ros/s >a;#or$ (TNF$)" -an #rans>or*/n ro=#,

>a;#or (TF). a#$a# /n/ -a8a# *ens#/*ulas/ sel sel !era#/nos/# *a#r/!s !oles#ea#o*a ers/>a#

,/8er8lo>era#/>" -es#ru!#/>" -an *a*8u eran/oenes/s. 0

'assa !oles#ea#o*a /n/ a!an *ene!an -an *en-esa! oran -/ se!/#arn7a ser#a

*en/*ul!an ne!ros/s #er,a-a8 #ulan. Terja-/n7a 8roses ne!ros/s #er,a-a8 #ulan -/8er,ea#

ole, !arena 8e*en#u!an rea!s/ asa* ole, 8e*usu!an a!#er/. &roses ne!ros/s #ulan /n/

*e*8er*u-a, #/*uln7a !o*8l/!as/ se8er#/ la/r/n/#/s" *en/n/#/s -an ases o#a!. 0

Tanda klinik OMSK tipe 'a(aya

'en/na# O'SK #/8e a,a7a ser/n!al/ *en/*ul!an !o*8l/!as/ 7an era,a7a

*a!a 8erlu -/#ea!!an -/anos/s -/n/. Walau8un -/anos/s 8as#/ aru -a8a# -/#ea!!an -/

!a*ar o8eras/" na*un eera8a #an-a !l/n/! -a8a# *enja-/ 8e-o*an a!an a-an7a O'SK

#/8e a,a7a" 7a/#u 8er>oras/ 8a-a *ar/nal a#au 8a-a a#/!. Tan-a /n/ /asan7a *eru8a!an

#an-a -/n/ -ar/ O'SK #/8e a,a7a" se-an!an 8a-a !asus 7an su-a, lanju# -a8a# #erl/,a#

ases a#au >/s#el re#roaur/!uler (ela!an #el/na)" 8ol/8 a#au jar/nan ranulas/ -/ l/an#el/na luar 7an erasal -ar/ -ala* #el/na #ena," #erl/,a# !oles#ea#o*a 8a-a #el/na #ena,"

(ser/n #erl/,a# -/ e8/#/*anu*)" se;re# eren#u! nana, a#au erau !,as (aro*a

!oles#ea#o*a) a#au #erl/,a# a7anan !oles#ea#o*a 8a-a >o#o ron#en *as#o/-. 0

Komplikasi Otitis Media Supuratif

O#/#/s *e-/a su8ura#/>" a/! 7an a!u# *au8un !ron/s" *e*8un7a/ 8o#ens/ un#u! *enja-/ ser/us !arena !o*8l/!as/n7a 7an -a8a# *enan;a* !ese,a#an -an -a8a#

*en7ea!an !e*a#/an. %en#u! !o*8l/!as/ /n/ #eran#un 8a-a !ela/nan 8a#olo/! 7an

*en7ea!an !e*a#/an. %en#u! !o*8l/!as/ /n/ #eran#un a8-a !ela/nan 8a#olo/! 7an

*en7ea!an o#ore. %/asan7a !o*8l/!as/ -/-a8a#!an 8a-a 8as/en O'SK #/8e a,a7a" #e#a8/

O'SK #/8e a*an 8un -a8a# *en7ea!an sua#u !o*8l/!as/" /la #er/n>e!s/ !u*an 7an

/rulen. Denan #erse-/an7a an#//o#/!a *u#a,/r !o*8l/!as/ o#oen/! se*a!/n jaran.

&e*er/an oa# oa#an ser/n *en7ea!an ejala -an #an-a !l/n/s !o*8l/!as/ O'SK


12/22

*enja-/ !uran jelas. al #erseu# *en7ea!an 8en#/nn7a *enenal 8ola 8en7a!/# 7an

er,uunan -enan !o*8l/!as/ /n/. 0

&en7earan 8en7a!/#

Ko*8l/!as/ o#/#/s *e-/a #erja-/ a8a/la sa=ar (arr/er) 8er#a,anan #el/na #ena,

7an nor*al -/le=a#/ se,/na *e*un!/n!an /n>e!s/ *enjalar !e s#ru!#ur -/ se!/#arn7a.

&er#a,anan 8er#a*a /ala, *u!osa saluran na>as *a*8u *elo!al/sas/ /n>e!s/. %/la sa=ar /n/

run#u," *as/, a-a sa=ar !e-ua" 7a/#u -/n-/n #ulan !au* #/*8an/ -an sel *as#o/-. %/la

sa=ar /n/ run#u," *a!a s#ru!#ur luna! -/ se!/#arn7a a!an #er!ena. Run#u,n7a 8er/os#eu* a!an

*en7ea!an #erja-/n7a ases su8er/os#eal" sua#u !o*8l/!as/ 7an rela#/e #/-a! era,a7a.

A!/a# /n>e!s/ *eara, !e -ala* #ulan #e*8oral" *a!a a!an *en7ea!an 8ares/s N

Fa;/al/s a#au la/r/n/#/s. %/la !ea ra, !ran/al" a!an *en7ea!an ases e!s#ra-ural"

#ro*o>le/#/s s/nus la#eral/s" *en/n/#/s -an ases o#a!. %/la sa=ar #ulan #erla*8au/" sua#u

-/n-/n 8er#a,anan !e#/a 7a/#u jar/nan ranulas/ a!an #eren#u!. &a-a o#/#/s *e-/a su8ura#/>

a!u# a#au sua#u e!saseras/ a!u# 8en7earan /asan7a *elalu/ os#eo#ro*o>le/#/s

(,e*a#oen). Se-an!an 8a-a !asus 7an !ron/s" 8en7earan #erja-/ *elalu/ eros/ #ulan.

Cara 8en7earan la/nn7a /ala, #o!s/n *asu! *elalu/ jalan 7an su-a, a-a" */saln7a *elalu/

>enes#ra ro#un-u*" *ea#us a!us#/!us /n#ernus" -u!#us 8er/l/*>a#/! -an -u!#us en-ol/*>a#/!. 0

Dar/ ejala -an #an-a 7an -/#e*u!an" -a8a# -/8er!/ra!an jalan 8en7earan sua#u

/n>e!s/ #el/na #ena, !e /n#ra;ran/al. Ter-a8a# 4 *a;a* 8en7earan 8en7a!/# O#/#/s 'e-/a

0. &en7earan ,e*a#oen

&en7earan *elalu/ os#eo#ro*o>le/#/s -a8a# -/!e#a,u/ -enan a-an7a +

a. Ko*8l/!as/ #erja-/ 8a-a a=al sua#u /n>e!s/ a#au e!saseras/ a!u#" -a8a# #erja-/

8a-a ,ar/ 8er#a*a a#au !e-ua sa*8a/ ,ar/ !e se8ulu,

. ejala 8ro-ro*al #/-a! jelas se8er#/ -/-a8a#!an 8a-a ejala *en/n/#/s lo;al

;. &a-a o8eras/" -/-a8a#!an -/n-/n #ulan #el/na #ena, u#u," -an #ulan ser#a

la8/san *u!o8er/os#eal *era-an -an *u-a, er-ara," se,/na -/seu# jua

*as#o/-/#/s ,e*ora/!a

1. &en7earan *elalu/ eros/ #ulan

&en7earan *elalu/ eros/ #ulan -a8a# -/!e#a,u/" /la +

a. Ko*8l/!as/ #erja-/ eera8a */nu a#au le/, se#ela, a=al 8en7a!/#

. ejala 8ro-ro*al /n>e!s/ lo;al /asan7a *en-a,ulu/ ejala /n>e!s/ 7an le/,

luas" */saln7a 8ares/s N >a;/al/s r/nan 7an ,/lan #/*ul *en-a,ulu/ 8ares/s

n Fa;/al/s 7an #o#al" a#au ejala *en/n/#/s lo;al *en-a,ulu/ 7an 8urulen#


13/22

;. &a-a o8eras/ -a8a# -/#e*u!an la8/san #ulan 7an rusa! -/ an#ara >o;us

su8uras/ -enan s#ru!#ur se!/#arn7a. S#ru!#ur jar/nan luna! 7an #eru!a

/asan7a -/la8/s/ ole, jar/nan ranulas/.

4. &en7earan *elalu/ jalan 7an su-a, a-a

&en7earan ;ara /n/ -a8a# -/!e#a,u/ /la +a. Ko*8l/!as/ #erja-/ 8a-a a=al 8en7a!/#

. A-a seranan la/r/n/#/s a#au *en/n/#/s erulan" *un!/n -a8a# -/#e*u!an

>ra!#ur #enoro!" r/=a7a# o8eras/ #ulan a#au r/=a7a# o#/#/s *e-/a 7an su-a,

se*u,. Ko*8l/!as/ /n#ra;ran/al *en/!u#/ !o*8l/!as/ la/r/n/#/s su8ura#/>

;. &a-a o8eras/ -a8a# -/#e*u!an jalan 8enjalaran *elalu/ sa=ar #ulan 7an

u!an ole, !arena eros/. 0

%eera8a 8enul/s *ene*u!a!an !las/>/!as/ !o*8l/!as/ o#/#/s *e-/a 7an su8ura#/> -/a/

*enja-/ + 0

0. Ko*8l/!as/ -/ #el/na #ena,

A!/a# /n>e!s/ #el/na #ena, ,a*8/r selalu eru8a #ul/ !on-u!#/>. &a-a *e*rane

#/*8an/ 7an *as/, u#u," #e#a8/ ran!a/an #ulan 8en-enaran #er8u#us" a!an

*en7ea!an #ul/ !on-u!#/> 7an era#. %/asan7a -eraja# #ul/ !on-u!#/> #/-a! selalu

er,uunan -enan 8en7a!/#n7a" sea jar/nan 8a#olo/s 7an #er-a8a# -/ !au*

#/*8an/ 8un" */saln7a !oles#ea#o*a -a8a# *en,an#ar!an suara !e #el/na -ala*.

a. &er>oras/ *e*rane #/*8an/ 8ers/s#en . Kerusa!an #ulan 8en-enaran

;. &ares/s nerus >a;/al/s

Nerus >a;/al/s -a8a# #er!ena ole, 8en7earan /n>e!s/ lansun !e

!anal/s >a;/al/s 8a-a o#/#/s *e-/a a!u#. &a-a o#/#/s *e-/a !ron/s !erusa!an

#erja-/ ole, eros/ #ulan ole, !oles#ea#o* a#au ole, jar/nan ranulas/" -/susul

ole, /n>e!s/ !e -ala* !anal/s >a;/al/s #erseu#.

&a-a o#/#/s *e-/a a!u# o8eras/ -e!o*8res/ !anal/s >a;/al/s #/-a!

-/8erlu!an. &erlu -/er/!an an#//o#/!a -os/s #/n/ -an #era8/ 8enunjan

la/nn7a" ser#a *en,/lan!an #e!anan -/ -ala* !au* #/*8an/ -enan

-ra/nase. %/la -ala* jan!a =a!#u #er#en#u #ern7a#a #/-a! a-a 8era/!an

se#ela, -/u!ur -enan ele!#ro-/anos#/! (*/saln7a ele!#ro*/ora>/)" arula,

-/8/!/r!an un#u! *ela!u!an -e!o*8res/.

&a-a o#/#/s *e-/a su8ura#/> !ron/s" #/n-a!an -e!o*8res/ ,arus se>era

-/la!u!an #an8a ,arus *enunu 8e*er/!saan ele!#ro-/anos/#/!. 0

1. Ko*8l/!as/ -/ #el/na -ala*

A8a/la #er-a8a# 8en/n/an #e!anan -/ #el/na #ena, ole, 8ro-u! /n>e!s/" a-a

!e*un!/nan 8ro-u! /n>e!s/ /#u a!an *en7ear !e #el/na -ala* *elalu/ #/n!a8


14/22

ula# (>enes#ra ro#un-u*). Sela*a !erusa!an ,an7a sa*8a/ a/an asaln7a saja

/asan7a #/-a! *en/*ul!an !elu,an 8a-a 8as/en. A!an #e#a8/ a8a/la !erusa!an #ela,

*en7ear !e !o!lea a!an *enja-/ *asala,. al /n/ ser/n -/8a!a/ seaa/ /n-/!as/

un#u! *ela!u!an */r/no#o*/ seera 8a-a o#/#/s *e-/a a!u# 7an #/-a! *e*a/!

-ala* 39 ja* -enan 8enoa#an *e-/!a *en#osa saja. 0

&en7earan ole, 8roses -es#ru!s/ se8er#/ ole, !oles#ea#o*a a#u /n>e!s/

lansun !e la/r/n a!an *en7ea!an anuan !ese/*anan -an 8en-enaran.

'/saln7a er#/o" *ual -an *un#a," ser#a #ul/ sara>. 0

a. F/s#ula la/r/n -an la/r/n/#/s

O#/#/s *e-/a su8ura#/> !ron/s #eru#a*a 7an -enan !oles#ea#o*" -a8a#

*en7ea!an #erja-/n7a !erusa!an 8a-a a/an es#/uler la/r/n" se,/na

#eren#u! >/s#ula. &a-a !ea-aan /n/ /n>e!s/ -a8a# *asu!" se,/na #erja-/

la/r/n/#/s -an a!,/rn7a a!an #erja-/ !o*8l/!as/ #ul/ #o#al a#au *en/n/#/s.

F/s#ula -/ la/r/n -a8a# -/!e#a,u/ -enan #es >/s#ula" 7a/#u -enan

*e*er/!an #e!anan u-ara 8os/#/> a#au nea#/e !e l/an #el/na *elalu/

o#os!o8 S/eel -enan ;oron #el/na 7an !e-a8 a#au alon !are# -enan

en#u! el/8s 8a-a ujunn7a 7an -/*asu!!an !e -ala* l/an #el/na. %alon

!are# -/8en;e# -an u-ara -/ -ala*n7a a!an *en7ea!an 8erua,an #e!anan

u-ara -/ l/an #el/na. %/la >/s#ula 7an #erja-/ *as/, 8a#en" *a!a a!an #erja-/

!o*8res/ -an e!s8ans/ la/r/n *e*rane. Tes >/s#ula 8os/#/> a!an

*en/*ul!an n/s#a*us a#au er#/o. Tes >/s#ula /sa nea#/e" /la >/s#ulan7a

su-a, #er#u#u8 ole, jar/nan ranulas/ a#au /la la/r/n su-a, *a#/ a#au 8ares/s

!anal.

&e*er/!saan ra-/olo/; #o*ora>/ a#au CT S;an 7an a/! !a-an

!a-an -a8a# *e*8erl/,a#!an >/s#ula la/r/n 7an /asan7a -/#e*u!an -/

!anal/s se*/s/r!ular/s ,or/on#al.

&a-a >/s#ula la/r/n a#au la/r/n/#/s" o8eras/ ,arus seera -/la!u!an

un#u! *en,/lan!an /n>e!s/ -an *enu#u8 >/s#ula" se,/na >uns/ #el/na

-ala* -a8a# 8ul/, !e*al/. T/n-a!an e-a, 7an a-e!ua#" un#u! *enon#rol

8en7a!/# 8r/*er. 'a#r/!s !oles#ea#o*a -an jar/nan ranulas/ ,arus -/an!a#

-ar/ >/s#ula sa*8a/ ers/, -an -aera, #erseu# ,arus seera -/#u#u8 -enan

jar/nan /!a# a#au se!e8/n #ulan #ulan ra=an.

. La/r/n/#/s

La/r/n/#/s 7an *enena/ seluru, a/an la/r/n" -/seu# la/r/n/#/s

u*u* (eneral)" -enan ejala er#/o era# -an #ul/ sara> era#" se-an!an


15/22

la/r/n/#/s 7an #era#as (s/r!u*s!r/8#a) *en7ea!an #erja-/n7a er#/o saja

a#au #ul/ sara> saja.

La/r/n/#/s #erja-/ ole, !arena 8en7earan /n>e!s/ !e ruan 8er/l7*8,.

Ter-a8a# 1 en#u! la/r/n/#/s" 7a/#u la/r/n/#/s serosa -an su8ura#/>. La/r/n/#/s

serosa -a8a# #eren#u! la/r/n/#/s serosa -/>us -an la/r/n/#/s serosa

s/r!u*s!r/8#a. La/r/n/#/s su8ura#/> -/a/ -ala* en#u! la/r/n/#/s su8ura#/>

a!u -/>us -an la/r/n/#/s su8ura#/> !ron/! -/>us.

&a-a la/r/n/#/s serosa #o!s/n *en7ea!an -/s>uns/ serosa #o!s/n

*en7ea!an -/s>uns/ la/r/n #an8a /nas/ sel ra-an" se-an!an 8a-a

la/r/n/#/s su8ura#/>" sel ra-an *en/nas/ la/r/n" se,/na #erja-/ !erusa!an

7an /rreers/le" se8er#/ >/ros/s -an os/>/!as/.

&a-a !e-ua en#u! la/r/n/#/s /#u o8eras/ ,arus seera -/la!u!an un#u!

*en,/lan!an /n>e!s/ -ar/ #el/na #ena,. Ka-an !a-an -/8erlu!an jua

-ra/nase nana, -ar/ la/r/n un#u! *en;ea, #erja-/n7a *en/n/#/s. &e*er/an

an#//o#/!a 7an a-e!ua# #eru#a*a -/#ujunan !e8a-a 8enoa#an o#/#/s *e-/a

!ron/! -enan a#au #an8a !oles#ea#o*a. 0

4. Ko*8l/!as/ !e e!s#ra-ural

a. &e#ros/#/s

K/ra !/ra se8er#/a -ar/ 8o8ulas/ *anus/a" #ulan #e*8oraln7a

*e*8un7a/ sel sel u-ara sa*8a/ !e a8e!s os 8e#rosu*. Ter-a8a# eera8a ;ara

8en7earan /n>e!s/ -ar/ #el/na #ena, !e os 8e#rosu*. an ser/n /ala,

8en7earan lansun !e sel sel u-ara #erseu#.

A-an7a 8e#ros/#/s su-a, ,arus -/;ur/a/ a8a/la 8a-a 8as/en o#/#/s

*e-/a #er-a8a# !elu,an -/8lo8/a" !arena !ele*a,an N VI. Ser/n!al/ -/ser#a/

-enan rasa n7er/ -/ -aera, 8ar/e#al" #e*8oral a#au o!s/8/#al" ole, !arena

#er!enan7a N V -/#a*a, -enan #er-a8a#n7a o#ore 7an 8ers/s#en"

#eren#u!la, sua#u s/n-ro* 7an -/seu# ss/n-ro* ra-en/o.

Ke;ur/aan #er,a-a8 8e#ros/#/s #eru#a*a /la #er-a8a# nana, 7an

!eluar #erus *enerus -an rasa n7er/ 7an *ene#a8 8as;a *as#o/-e!#o*/.

&enoa#an 8e#ros/#/s /ala, o8eras/ ser#a 8e*er/an an#//o#/!a

8ro#o;ol !o*8l/!as/ /n#ra;ran/al. &a-a =a!#u *ela!u!an o8eras/ #el/na

#ena, -/la!u!an jua e!s8loras/ sel sel u-ara #ulan 8e#rosu* ser#a

*eneluar!an jar/nan 8a#,oen.

. Tro*o>le/#/s s/nus la#eral/s

Inas/ /n>e!s/ !e s/nus s/*o/- !e#/!a *ele=a#/ #ulan *as#o/- a!an

*en7ea!an #erja-/n7a #,ro*os/s s/nus la#eral/s. Ko*8l/!as/ /n/ ser/n

-/#e*u!an 8a-a a*an 8ra$an#//o#/!" #e#a8/ !/n/ su-a, jaran #erja-/.


16/22

De*a* 7an #/-a! -a8a# -/#eran!an 8en7ean7a *eru8a!an #an-a

8er#a*a -ar/ /n>e!s/ 8e*ulu, -ara,. &a-a *ulan7a su,u #uu, #urun na/!"

#e#a8/ se#ela, 8en7a!/# *enja-/ era# -/-a8a#!an !ura su,u 7an na/! #urun

-enan sana# ;ura* -/ser#a/ -enan *en//l. Kura su,u -e*/!/an

*enan-a!an a-an7a se8s/s.

Rasa n7er/ /asan7a #/-a! jelas" !e;ual/ /la su-a, #er-a8a# ases

8er/s/nus. Kul#ur -ara, /asan7a 8os/#/>" #eru#a*a /la -ara, -/a*/l /la

-e*a*.

&enoa#an ,arusla, -enan jalan e-a," *e*uan su*er /n>e!s/ -/

sel sel *as#o/-" *e*uan #ulan 7an era#asan -enan s/nus (s/nus 8la#e)

7an ne!ro#/!" a#au *e*uan -/n-/n s/nus 7an #er/n>e!s/ a#au ne!ro#/!.

J/!a su-a, #eren#u! #,ro*us ,arus jua -/la!u!an -ra/nase s/nus -an*eneluar!an #,ro*us. Seelu* /#u -/la!u!an -ulu l/ase ena juulare

/n#erna a#au *en;ea, #,ro*us #erle8as !e 8aru -an !e -ala* #uu, la/n.

;. Ases e!s#ra-ural

Ases e!s#ra-ural a-ala, #er!u*8uln7a nana, -/ an#ara -ura*e#er -an

#ulan. &a-a o#/#/s *e-/a su8ura#/> !ron/s !ea-aan /n/ er,uunan -enan

jar/nan ranulas/ -an !oles#ea#o*a 7an *en7ea!an eros/ #e*en #/*8an/

a#au *as#o/-.

ejala u#a*an7a eru8a n7er/ #el/na ,ea# -an n7er/ !e8ala. Denan

>o#o ron#en *as#o/- 7an a/!" #eru#a*a 8os/s/ S;,uller" -a8a# -/l/,a#

!erusa!an -/ le*8en #e*en 7an *enan-a!an #er#e*usn7a #e*en. &a-a

u*u*n7a ases /n/ aru -/!e#a,u/ 8a-a =a!#u o8eras/ *as#o/-e!#o*/.

-. Ases su-ural

Ases su-ural jaran #erja-/ seaa/ 8erluasan lansun -ar/ ases

e!s#ra-ural /asan7a seaa/ 8erluasan #ro*o>le/#/s *elalu/ 8e*ulu, ena.

ejalan7a -a8a# eru8a -e*a*" n7er/ !e8ala" -an 8enurunan

!esar-aran sa*8a/ !o*a 8a-a 8as/en O'SK. ejala !ela/nan susunan sara>

8usa# /sa eru8a !ejan" ,e*/8le/a -an 8a-a 8e*er/!saan #er-a8a# #an-a

!ern/ 8os/#/>.

&uns/ lu*al 8erlu un#u! *e*e-a!an ases su-ural -enan

*en/n/#/s. &a-a ases su-ural 8a-a 8e*er/!saan CSS !a-ar 8ro#e/n /asan7a

nor*al -an #/-a! -/#e*u!an nor*al. Kalau 8a-a ases e!s#ra-ural nana,

!eluar 8a-a =a!#u o8eras/ *as#o/-e!#o*/" 8a-a ases su-ural nana, ,arus

-/!eluar!an se;ara e-a, sara> (neuro$sur/;al)" seelu* -/la!u!an o8eras/

*as#o/-e!#o*/. 0

3. Ko*8l/!as/ !e susunan sara> 8usa#


17/22

a. 'en/n/#/s

Ko*8l/!as/ o#/#/s *e-/a !e susunan sara> 8usa# 7an 8al/n ser/n

/ala, *en/n/#/s. Kea-aan /n/ -a8a# #erja-/ ole, O'A" *au8un !ron/s" ser#a

-a8a# #erlo!al/sas/" a#au u*u* (eneral). Walau se;ara !l/n/! !e-ua en#u! /n/

*/r/8" 8a-a 8e*er/!saan CSS #er-a8a# a!#er/ 8a-a en#u! 7an u*u*

(eneral)" se-an!an 8a-a en#u! 7an #erlo!al/sas/ #/-a! -/#e*u!an a!#er/.

a*aran !l/n/! *en/n/#/s /asan7a eru8a !a!u !u-u!" !ena/!an

su,u #uu," *ual" *un#a," 7an !a-an !a-an *un#a,n7a *un;ra#

(8ro7e!#/>)" ser#a n7er/ !e8ala ,ea#. &a-a !asus 7an era# /asan7a

!esa-aran *enurun (-el/r/u* sa*8a/ !o*a). &a-a 8e*er/!saan !l/n/! #er-a8a#

!a!u !u-u! =a!#u -/>le!s/!an -an #er-a8a# #an-a !ern/ 8os/#/>. %/asan7a

!a-ar ula *enurun -an !a-ar 8ro#e/n *en/n/ -/ CSS.&enoa#an *en/n/#/s o#oen/! /n/ /ala, -enan *enoa#/

*en/n/#/sn7a -ulu -enan an#//o#/; 7an sesua/" !e*u-/an /n>e!s/ -/

#el/nan7a -/#anulan/ -enan o8eras/ *as#o/-e!#o*/.

. Ases o#a!

Ases o#a! seaa/ !o*8l/!as/ o#/#/s *e-/a -an *as#o/-/#/s -a8a#

-/#e*u!an -/ sereelu*" >osa !ran/al 8os#er/or a#au -/ lous #e*8oral" -/ >osa

!ran/al *e-/a. Kea-aan /n/ ser/n er,uunan #ro*o>le/#/s s/nus la#eral/s"

8e#ros/#/s" a#au *en/n/#/s. Ases o#a! /asan7a *eru8a!an 8erluasan lansun

-ar/ /n>e!s/ #el/na -an *as#o/- a#au #ro*o>le#/#/s. U*u*n7a -/-a,ulu/ ole,

sua#u ases e!s#ra-ural.

ejala ases sereelu* /asan7a le/, jelas -ar/8a-a ases lous

#e*8oral. Ases sereelu* -a8a# -/#an-a/ -enan a#a!s/a" -/s-/a-o!o!/nes/s"

#re*or /n#ens/> -an #/-a! #e8a# *enunju! sua#u oje!. A>as/a -a8a# #erja-/ 8a-a

ases lous #e*8oral. ejala la/n 7an *enunju!!an a-an7a #o!s/s/#as" eru8a

n7er/ !e8ala" -e*a*" *un#a, ser#a !ea-aan le#ar/!. Sela/n /#u seaa/ #an-a

7an n7a#a sua#u ases o#a! /ala, na-/ 7an la*a# ser#a seranan !ejan.

&e*er/!saan CSS *e*8erl/,a#!an !a-ar 8ro#e/n 7an *en/n/ ser#a

!ena/!an #e!anan l/Guor. 'un!/n jua #er-a8a# e-e*a 8a8/l. Lo!as/ ases

-a8a# -/#en#u!an -enan 8e*er/!saan an/ora>/" en#r/!ulora>/ a#au -enan

#o*ora>/ ;o*8u#er.

&enoa#an ases o#a! /ala, -enan an#//o#/!a 8aren#eral -os/s #/n/

(8ro#o;ol #era8/ !o*8l/!as/ /n#ra;ran/al)" -enan a#au #an8a o8eras/ un#u!

*ela!u!an -renas/ -ar/ les/. Sela/n /#u 8enoa#an -enan an#//o#/!a ,arus


18/22

/n#ens/>. 'as#o/-e!#o*/ -/la!u!an un#u! *e*uan su*er /n>e!s/" 8a-a

=a!#u !ea-aan u*u* le/, a/!.

;. /-rose>alus o#/#/s

/-rose>alus o#/#/s -/#an-a/ -enan 8en/n/an #e!anan CSS 7an

,ea# #an8a a-an7a !ela/nan !/*/a=/ -ar/ l/Guor /#u. &a-a 8e*er/!saan

#er-a8a# e-e*a 8a8/l. Kea-aan /n/ -a8a# *en7er#a/ O'A" *au8un O'K.

ejala eru8a n7er/ !e8ala 7an *ene#a8" -/8lo8/a" 8an-anan 7an !aur"

*ual" -an *un#a,. Kea-aan /n/ -/8er!/ra!an -/sea!an ole, #er#e!ann7a

s/nus la#eral/s 7an *ena!/a#!an !eaalan asro8s/ l/Guor sereros8/nal

ole, la8/san ara!no/-. 0

e!s/ 8a-a #el/na

#ena,.'as#o/-/#/s a-ala, 8en7a!/# se!un-er -ar/ o#/#/s *e-/a 7an #/-a! se*u,. <

Terapi OMSK

Tera8/ O'SK #/-a! jaran *e*erlu!an =a!#u la*a" ser#a ,arus erulan ulan.

Se;re# 7an !eluar #/-a! ;e8a# !er/n a#au selalu !a*u, la/. Kea-aan /n/ an#ara la/n

-/sea!an ole, sa#u a#au eera8a !ea-aan" 7a/#u + 0

0. A-an7a 8er>oras/ *e*rane #/*8an/ 7an 8er*anen" se,/na #el/na #ena,

er,uunan -enan -un/a luar

1. Ter-a8a# su*er /n>e!s/ -/ >ar/n" naso>ar/n" ,/-un" -an s/nus 8aranasal

4. Su-a, #eren#u! jar/nan 8a#olo/! 7an /reers/el -ala* rona *as#o/-

3. // -an ,//ena 7an !uran0

&r/ns/8 #era8/ O'SK #/8e a*an /ala, !onsera#/> a#au -enan *e-/!a*en#osa. %/la

se;re# 7an !eluar #erus *enerus" *a!a -/er/!an oa# 8en;u;/ #el/na" eru8a laru#an 1O1

4B sela*a 4$< ,ar/. Se#ela, se;re# er!uran *a!a #era8/ -/lanju#!an -enan *e*er/!an

oa# #e#es #el/na 7an *enan-un an#//o#/!a -an !or#/!os#ero/- . an7a! a,l/ er8en-aoa#

a,=a se*ua oa# #e#es 7an -/jual -/ 8asaran /n/ *enan-un an#//o#/!a 7an ers/>a#

o#o#o!s/!. Ole, sea /#u 8enul/s *enanjur!an aar oa# #e#es #el/na janan -/er/!an

se;ara #erus *enerus le/, -ar/ 0 a#au 1 */nu a#au 8a-a O'SK 7an su-a, #enan. Se;ara

oral -/er/!an an#//o#/!a -ar/ olonan a*8/s/l/n a#au er/#ro*/s/n (/la 8as/en aler/ #er,a-a8

8en/s/l/n)" seelu* ,as/l #es res/s#ens/ -/#er/*a. &a-a /n>e!s/ 7an -/;ur/a/ !arena

8en7ean7a #ela, res/s#en #er,a-a8 a*8/s/l/n -a8a# -/er/!an a*8/s/l/n asa* !laulana#. 0


19/22

%/la se;re# #ela, !er/n" #e#a8/ 8er>oras/ *as/, a-a se#ela, -/oseras/ sela*a 1 ulan"

*a!a /-ealn7a -/la!u!an */r/no8las#/ a#au #/*8ano8las#/. O8eras/ /n/ er#ujuan un#u!

*en,en#/!an /n>e!s/ se;ara 8er*anen" *e*8era/!/ *e*rane #/*8an/ 7an 8er>oras/"

*en;ea, #erja-/n7a !o*8l/!as/ a#au !erusa!an 8en-enaran 7an le/, era#" ser#a

*e*8era/!/ 8en-enaran. 0

%/la #er-a8a# su*er /n>e!s/ 7an *en7ea!an se;re# #e#a8 a-a" a#au #erja-/n7a

/n>e!s/ erulan" *a!a su*er /n>e!s/ /#u ,arus -/oa#/ #erle/, -a,ulu" *un!/n jua 8erlu

*ela!u!an 8e*e-a,an" */saln7a a-eno/-e!#o*/ -an #ons/le!#o*/. 0

a*ar 1+ #/*8ano8las#/. Su*er oole I*ae

&r/ns/8 #era8/ O'SK #/8e a,a7a /ala, 8e*e-a,an" 7a/#u *as#o/-e!#o*/. Ja-/ /la#er-a8a# O'SK #/8e a,a7a" *a!a #era8/ 7an #e8a# /ala, -enan *ela!u!an *as#o/-e!#o*/

-enan a#au #an8a #/*8ano8las#/. Tera8/ !onsera#/> -enan *e-/!a *en#osa ,an7ala,

*eru8a!an #era8/ se*en#ara seelu* -/la!u!an 8e*e-a,an. %/la #er-a8a# ases

su8er/os#eal re#roaur/!uler" *a!a /ns/s/ ases sea/!n7a -/la!u!an #ersen-/r/ seelu*

*as#o/-e!#o*/. 0

A-a eera8a jen/s 8e*e-a,an a#au #e,n/! o8eras/ 7an -a8a# -/la!u!an

8a-a O'SK -enan *as#o/-/#/s !ron/s" a/! #/8e en/na a#au *al/na" an#ara la/n +

a. 'as#o/-e!#o*/ se-er,ana (s/*8le *as#o/-e;#o*7)

O8eras/ /n/ -/la!u!an 8a-a O'SK #/8e a*an 7an -enan 8enoa#an

!onsera#/> #/-a! se*u,. Denan #/n-a!an o8eras/ /n/ -/la!u!an 8e*ers/,an

ruan *as#o/- -ar/ jar/nan 8a#olo/!. Tujuann7a /ala, su8a7a /n>e!s/ #enan

-an #el/na #/-a! era/r la/. &a-a o8eras/ /n/ >uns/ 8en-enaran #/-a!

-/8era/!/. 0

. 'as#o/-e!#o*/ ra-/!al


20/22

O8eras/ /n/ -/la!u!an 8a-a O'SK a,a7a -enan /n>e!s/ a#au

!oles#ea#o*a 7an su-a, *eluas. 0

&a-a o8eras/ /n/ rona *as#o/- -an !au* #/*8an/ -/ers/,!an -ar/

se*ua jar/nan 8a#olo/!. D/n-/n a#as an#ara l/an #el/na luar -an #el/na

#ena, -enan rona *as#o/- -/run#u,!an" se,/na !e#/a -aera, ana#o*/

#erseu# *enja-/ 0 ruanan. Tujuan o8eras/ /n/ /ala, un#u! *e*uan se*ua

jar/nan 8a#olo/! -an *en;ea, !o*8l/!as/ !e /n#ra;ran/al. 0

Keru/an o8eras/ /n/ /ala, 8as/en #/-a! -/8erole,!an erenan seu*ur

,/-u8n7a. &as/en ,arus -a#an -enan #era#ur un#u! ;on#rol su8a7a #/-a!

#erja-/ /n>e!s/ !e*al/. &en-enaran er!uran se!al/" se,/na -a8a#

*en,a*a# 8en-/-/!an a#au !ar/er 8as/en. 0

'o-/>/!as/ o8eras/ /n/ /ala, -enan *e*asan #an-ur (ra>#) 8a-a

rona o8eras/ ser#a *e*ua# *ea#o8las#/ 7an lear" se,/na rona o8eras/

!er/n 8er*anen" #e#a8/ #er-a8a# ;a;a# ana#o*/" 7a/#u *ea#us l/an #el/na luar

*enja-/ lear. 0

;. 'as#o/-e!#o*/ ra-/!al -enan *o-/>/!as/ (O8eras/ %on-7)

O8eras/ /n/ -/la!u!an 8a-a O'SK -enan !oles#ea#o*a -/ -aera,

a#/!a8/ elu* *erusa! !au* #/*8an/. Seluru, rona *as#o/- -/ers/,!an

-an -/n-/n 8os#er/or l/an #el/na -/ren-a,!an. 0

Tujuan o8eras/ /ala, un#u! *e*uan se*ua jar/nan 8a#olo/! -ar/

rona *as#o/- -an *e*8er#a,an!an 8en-enaran 7an *as/, a-a. 0

-. '/r/no8las#/

O8eras/ /n/ *eru8a!an jen/s #/*8ano8las#/ 7an 8al/n r/nan" -/!enal

jua -enan na*a #/*8ano8las#/ #/8e I. re!ons#ru!s/ ,an7a -/la!u!an 8a-a

*e*rane #/*8an/.

Tujuan o8eras/ /ala, un#u! *en;ea, erulann7a /n>e!s/ #el/na

#ena, 8a-a O'SK #/8e a*an -enan 8er>oras/ 7an *ene#a8. 0

O8eras/ /n/ -/la!u!an 8a-a O'SK #/8e a*an 7an su-a, #enan

-enan !e#ul/an r/nan 7an ,an7a -/sea!an ole, 8er>oras/ *e*rane#/*8an/. 0

e. T/*8ano8las#/

O8eras/ /n/ -/!erja!an 8a-a O'SK #/8e a*an -enan !erusa!an 7an

le/, era# a#au O'SK #/8e a*an 7an #/-a! /sa -/#enan!an -enan

8enoa#an *e-/!a *en#osa. Tujuan o8eras/ /n/ /ala, un#u! *en7e*u,!an

8en7a!/# ser#a *e*8era/!/ 8en-enaran.

&a-a o8eras/ /n/ sela/n re!ons#ru!s/ *e*rane #/*8an/ ser/n !al/

,arus -/la!u!an jua re!ons#ru!s/ #ulan 8en-enaran. %er-asar!an en#u!


21/22

Gambar 3. Pedoman Tatalaksana OMSK1,6

Gambar 4. Algoritma 11,6

Gambar 5. Algoritma 21,6

re!ons#ru!s/ #ulan 8en-enaran 7an -/la!u!an *a!a -/!enal /s#/la,

#/*8ano8las#/ #/8e II" III" IV" -an V.

Seelu* re!ons#ru!s/ -/!erja!an le/, -a,ulu -/la!u!an e!s8loras/

!au* #/*8an/ -enan a#au #an8a *as#o/-e!#o*/" un#u! *e*ers/,!an

jar/nan 8a#olo/s. T/-a! jaran 8ula o8eras/ /n/ #er8a!sa -/la!u!an 1 #a,a8

-enan jara! =a!#u 6$01 ulan. 0

>. &en-e!a#an an-a #/*8ano8las#/ (Co*/ne- A88roa;, T7*8ano8las#7)

O8eras/ /n/ *eru8a!an #e!n/! o8eras/ #/*8ano8las#/ 7an -/!erja!an

8a-a !asus O'SK #/8e a,a7a a#au O'SK #/8e a*an -enan jar/nan

ranulas/ 7an luas.

Tujuan o8eras/ un#u! *en7e*u,!an 8en7a!/# ser#a *e*8era/!/

8en-enaran #an8a *ela!u!an #e!n/! *as#o/-e!#o*/ ra-/!al ( #an8a

*erun#u,!an -/n-/n 8os#er/or l/an #el/na).'e*ers/,!an !oles#ea#o*a -an jar/nan ranulas/ -/ !au* #/*8an/"

-/!erja!an *elalu/ 1 jalan (;o*/ne- a88roa;,) 7a/#u *elalu/ l/an #el/na -an

rona *as#o/- -enan *ela!u!an #/*8ano#o*/ 8os#er/or. Te!n/! o8eras/ /n/

8a-a O'SK #/8e a,a7a elu* -/se8a!a#/ ole, 8ara a,l/" ole, !arena ser/n

#erja-/ !a*u,n7a !oles#ea#o*a !e*al/. 0

Gambar 4. Algoritma 1


22/22

Daftar Pustaka

0. Soe8ar-/ EA" Is!an-ar N" %as,/ru--/n J" Res#u#/ RD. %u!u ajar /l*u !ese,a#an

#el/na ,/-un #enoro! !e8ala le,er. 5#, e-/#/on. Ja!ar#a+ %a-an &ener/# FK UI"

1203 .,. 61$5" 52$

Case Omsk pada Anak

Documents

Transcript of Case Omsk pada Anak